临床实践经验与中医理论的建构——经验思维与中医理论建构研究之二

临床实践经验是中医理论建构与不断发展的不竭动力,也是中医学在现代社会存在、发展的根本保障,以金元四大家的形成、瘀血生风病机的提出以及中风病机理论的创新为例,阐述了临床实践经验在中医理论建构中的价值。     

功能性鼻内窥镜鼻窦手术在基层医院开展的体会

目的介绍功能性鼻内窥镜鼻窦手术在基层医院开展的体会。方法分析250例慢性鼻一鼻窦炎、鼻息肉行功能性鼻内窥镜鼻窦手术的疗效。结果治愈210例,好转30例,无效10例,总有效率为96％.头痛完全缓解者150例,鼻塞完全消除者200例,脓鼻涕完全消失者186例,嗅觉完全或部分恢复者58例。结论功能性鼻内镜鼻窦手术具有视角宽阔、视野清晰、操作精细、创伤小等优点,对治疗慢性鼻一鼻窦炎,鼻息肉病疗效显著,基层医院如有条件应尽量开展。CT扫描及内镜检查分型对确定麻醉方式、手术方式有直接指导意义;完整的围手术期综合治疗和及时的术后处理,是保证疗效的重要手段．     

二级医院学科建设的实践与体会

本文分析了上海市第一人民医院宝山分院在学科建设中采取的措施及取得的成效,认为学科建设是提高和促进医院医疗质量的关键。体会到要取得学科建设的成功,必须开展管理创新、建立竞争机制、适应卫生改革和确立以人为本。     

老年病科开展临床药学的体会及经验

目的:探讨临床药师在老年病科患者用药监护中的工作方法和作用。方法:结合实际病例,针对老年病科患者生理、疾病特点,介绍老年病科开展临床药学的体会及经验。结果:临床药师在老年病科开展临床药学能够提高患者的药物治疗效果。结论:临床药师通过参与老年病科查房、监控用药全过程、追踪用药结果,能够全方位服务于患者。     

金实教授干燥综合征辨治经验

金实教授从医40余年,对干燥综合征的辨治积累了丰富的临床经验,从病因、病机、辨证、治疗及临床用药等方面较系统总结了金师经验,重点阐述了肺不布津,脉络滞涩是病理关键,肺失宣布、阴虚络滞为主要病机,生津润燥、宣肺通络乃治疗大法,本病主要证候为阴虚络滞证,金师创增液布津汤治疗干燥综合征,验之临床,疗效较好。     

大肠癌患者使用奥沙利铂联合化疗的护理体会

目的大肠癌患者联合化疗过程中有效预防/治疗不良反应的护理措施。方法34例中、晚期大肠癌患者给予奥沙利铂（130mg/m2静脉滴注4h,化疗第1天,）,第1～5天5-氟尿嘧啶（450mg/m2静脉滴注,4h滴完）和亚叶酸钙（0.2静脉滴注,5-氟尿嘧啶前）联合治疗,21d重复疗程,每例患者完成至少2个周期。结果34例患者完全缓解（CR）2例,部分缓解（PR）18例,总有效率为%,有效的护理干预能减少不良反应的发生,使患者配合治疗,提高生存率。结论奥沙利铂联合化疗存在不同程度的毒副反应,治疗过程中做好心理护理,注意观察,及时处理,能减轻毒副反应,提高生存质量。     

Orthopaedic patients' experience of motor vehicle accident in Singapore

Aim:  The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital.
Background:  Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients.
Method:  A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and 'snowballing'. Interviews were audiotaped and transcribed verbatim in preparation for analysis.
Findings:  The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation.
Conclusion:  The study provided an understanding of orthopaedic patients' experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims' experiences of MVAs and nurses caring for MVA victims.     

Explanatory models of influences on the construction and expression of user satisfaction

The paper asks why high levels of expressed satisfaction are recorded in settings where health care provision is manifestly inadequate. Qualitative interviews with 30 women aged 25–60 years from a rural district health system of Northeast Brazil were used to explore the applicability of three explanatory models of influences on the construction and expression of satisfaction: expectations; contextual dynamics; mediating filters. The first two of these models argue that a lack of information and a reluctance to be negative respectively lead to high expressed satisfaction that is artificial. The concept of mediating filters proposes that respondents construct an evaluation that takes account of wider issues, such that high levels of expressed satisfaction are, in this sense, real. All three models contribute towards answering the paper's question. However, our data suggest that it is an informed, but low, expectation of health care provision that leads to alternative strategies, including resort to patron–client networks, and success in gaining good health care that is important. Mediating filters identified in this study were culpability and the reference time-frame. We raise questions for practice and offer a combined explanatory model.     

Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?

Background  This study aimed to define the management and risk factors for intraoperative complications (IOC) and conversion in laparoscopic colorectal surgery, and to assess whether surgeon experience influences intraoperative outcomes. Methods  Consecutive patients undergoing laparoscopic colorectal procedures from 1991 to 2005 were analyzed from a longitudinal prospectively collected database. All patients referred to the four surgeons involved in this study were offered a minimally invasive approach. Patient characteristics, perioperative variables, and surgeon experience data were analyzed and compared. Results  A total of 991 consecutive laparoscopic colorectal procedures were studied. The majority of operations were performed for malignant disease (n = 526, 53%), and most frequently consisted of segmental colonic resections (n = 718, 72%). A total of 85 patients (8.6%) had an IOC. Patients experiencing an IOC had a significantly higher median body weight (75 versus 68 kg, p = 0.0047) and had a higher proportion of previous abdominal surgery (31% versus 20%, p = 0.029). Only 39% of patients suffering an IOC required conversion to open surgery. A total of 126 (13%) cases were converted to open surgery. On multivariable analysis, previous abdominal surgery [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.39–8.35, p = 0.0076] was independently associated with having an IOC and a conversion to open within the same procedure. With increasing experience, individual surgeons were found to operate on heavier patients (p = 0.025), and on patients who had a higher rate of previous intra-abdominal surgery (p < 0.0001). Despite these risk factors, the early and late experience demonstrated no significant difference in terms of IOCs (p = 0.54) and conversion to open surgery (p = 0.40). Conclusions  The majority of IOCs can be managed laparoscopically. With increasing experience surgeons can perform laparoscopic colorectal surgery on a patient population with a greater proportion of previous abdominal surgery and a higher mean body weight without adversely affecting their rates of intraoperative complications or conversion. Oral presentation at the Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons, April 12th, 2008, Philadelphia, PA.     

杨学信主任医师治疗高血压病的临床经验

杨学信老师在整理古代文献的基础上,结合临床实际,提出"多维平衡法"治疗眩晕的方法。从病因病机、学术思想、辨证经验、治则治法、组方用药五方面进行论述,系统的归纳了杨老师辨治高血压病的经验。这些经验对临床有重要的意义,值得进一步探讨。